skip to main content

SAH Aneurysm Timing — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

ModerateNeuroanaesthesiaSAH Aneurysm TimingFRCA Final

A 65-year-old man has an aneurysmal subarachnoid haemorrhage (Fisher grade 3, WFNS grade I). CT angiography identifies a 7 mm anterior communicating artery aneurysm compatible with the bleeding pattern. The specialist multidisciplinary team considers interventional treatment appropriate. According to current NICE guidance, when should the culprit aneurysm be secured?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — At the earliest opportunity

Explanation lettering: D = shown as A · A = shown as D

A is correct. NICE NG228 recommends that, when interventional treatment is planned, the culprit aneurysm should be secured at the earliest opportunity to prevent rebleeding. The risk of rebleeding is highest during the first 24 hours, but NICE does not define a rigid requirement that treatment must be completed within 24 hours. Deliberately waiting for 72 hours, 7 days or the end of the vasospasm-risk period leaves the aneurysm unsecured during a high-risk interval. Rebleeding is not a prerequisite for treatment. The WFNS grade should inform assessment but should not be used in isolation to determine treatment suitability or timing.

Reference: National Institute for Health and Care Excellence. NG228: Subarachnoid haemorrhage caused by a ruptured aneurysm: diagnosis and management, recommendations 1.2.4–1.2.8. 2022. https://www.nice.org.uk/guidance/ng228/chapter/Recommendations